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The optimal dose of aspirin in vascular diseases remains controversial. Although low aspirin doses (<100 mg daily) have potential advantages over higher doses, a recent meta-analysis has shown that in patients at high risk for vascular events, there was a similar reduction of events over a dose range of 75 to 1500 mg daily. The risk of major bleeding was similar in all aspirin doses equal to or less than 325 mg daily (1). Thus, we believe that the dose of aspirin used in our study (325 mg daily) is appropriate. The concern of excessive bleeding with a combined use of aspirin and fibrinolytic therapy is valid, but this does not apply to our study because none of our patients received fibrinolytic therapy. It is possible that other antiplatelet agents may have salutary effects in patients with infective endocarditis. Nonetheless, our study underscores that these patients have a high risk for excessive bleeding—14.5% major or minor bleeding cases in our patients on placebo—which needs to be considered in any future studies examining the role of antiplatelet agents in this clinical setting.

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